Differential Diagnosis for Hematoma Surrounding Midline

• Single Most Likely Diagnosis
  • Epidural hematoma: This is a common and serious condition where a hematoma forms between the skull and the dura mater, often due to trauma. The midline location is consistent with this diagnosis, as epidural hematomas can occur in the midline, especially if they are related to a fracture of the skull that crosses the midline or involves the sagittal sinus.
• Other Likely Diagnoses
  • Subdural hematoma: Although more commonly associated with lateral head trauma, subdural hematomas can also occur in the midline, particularly if there's a significant injury or if the hematoma has spread from a lateral location.
  • Subarachnoid hemorrhage: While this condition involves bleeding into the space surrounding the brain (the subarachnoid space), it can sometimes present with a collection of blood that appears as a hematoma on imaging, especially if the blood has accumulated in a way that it appears more localized.
• Do Not Miss Diagnoses
  • Intracranial aneurysm rupture: Although less common than traumatic causes of hematoma, a ruptured aneurysm can cause significant bleeding that might appear as a hematoma surrounding the midline, particularly if the aneurysm is located near the circle of Willis.
  • Arteriovenous malformation (AVM) rupture: Similar to an aneurysm rupture, an AVM can cause sudden and severe bleeding if it ruptures, potentially appearing as a midline hematoma.
• Rare Diagnoses
  • Dural sinus thrombosis: This condition involves a blood clot in the dural sinuses and can sometimes present with hemorrhage or hematoma formation, especially if there's associated venous infarction.
  • Hemorrhagic brain tumor: Certain brain tumors can bleed, and if they are located near the midline, they might present with a hematoma surrounding this area. However, this would be less common compared to other causes of midline hematoma.